Provider Demographics
NPI:1770132904
Name:RENAUD, CRYSTAL RAYE (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RAYE
Last Name:RENAUD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7131 W 135TH ST # 1107
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-1238
Mailing Address - Country:US
Mailing Address - Phone:913-423-9196
Mailing Address - Fax:
Practice Address - Street 1:120 S BROADWAY ST STE 8
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-4082
Practice Address - Country:US
Practice Address - Phone:913-423-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003936363LF0000X
KS5381893052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily